Is checking for orthostatic hypotension less than 1 minute after standing clinically useful?

Not only can it be useful in identifying those with history of dizziness upon standing but it may also predict a higher risk of falls, fracture, syncope and mortality long term. 1

Clinicians (myself included) have often assumed that drops in blood pressure (BP) and brief feeling of light-headedness soon after active standing are too common and “physiologic” to be of clinical utility,1,2 and have often discouraged checking for orthostatic hyotension (OH) sooner than 1 minute.

However, a 2017 report involving over 11,000 middle-aged participants (Atherosclerosis Risk in Communities Study) may make us rethink our position.1 This prospective study found a significant association between participant-reported history of dizziness on standing and OH (defined as a drop in BP systolic ≥20 mmHg or diastolic ≥10 mmHg) but only at 1st measurement (mean of 28.0 seconds after standing), not at subsequent ones over a 2 minute period.

The more intriguing finding was the association between OH documented < 1 minute after standing and increased risk of falls, fracture, syncope, and mortality over a median follow-up period of 23 years. Although there were limitations to the study (eg, excluding many patients likely to have more severe OH), it appears that “premature” checking for OH less than a minute after standing may not be useless!

Most, including the CDC, agree that rechecking the BP at 3 minutes is still indicated to identify those with sustained or delayed OH. 2,3